The Foundational Community Supports Program: Preliminary ......Program: Preliminary Evaluation Findings Materials Prepared by Taylor Danielson, Department of Social and Health Services,

1DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● FEBRUARY 2020

The Foundational Community Supports Program: Preliminary Evaluation Findings

Materials Prepared by Taylor Danielson, Department of Social and Health Services, Research and Data Analysis Division

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Enrolled Clients: The Treatment Group

Individuals enrolled in an FCS program from January 2018 through September 2018 according to ProviderOne payment data and in supported employment or supportive housing as of their enrollment month,*

18 years of age or older if enrolled in supportive housing OR 16 or older if in supported employed,

Correctly linked to their Automated Client Eligibility System (ACES) data,

Had a valid address/geographical location at enrollment,

Received any form of medical assistance in the six months prior to and following program entry, and

Were alive as of the last month of the six-month follow-up period.

*32 individuals enrolled in both services at enrollment were excluded from the analyses.


Comparison Group Identification

Received qualifying forms of medical assistance in a given month,*

Met age, needs-based, and risk-based program eligibility criteria during the intake window,

Had not enrolled in FCS services as of September 2019,

Correctly linked to their Automated Client Eligibility System (ACES) data,

Had a valid address/geographical location in a given month,

Received any form of medical assistance in the six months prior to and following the month that they qualified for FCS services, and

Were alive as of the last month of the six-month follow-up period.

*The pool of potential controls may include multiple months where an individual qualified for but did not receive FCS services. Each month that an individual qualified for the program is treated as a separate observation for comparison group selection.


Study Design and Matching Process

1. Analyses were stratified by delivery system affiliation and program type. Individuals were assigned to ALTSA population if they had a CARE assessment in the 15 months prior to and including their index month. Otherwise, they were assigned to HCA.

2. Matched comparison group analysis.

• Propensity score matching using 2:1 matching ratio without replacement.

• Exact matching on dual-eligibility for Medicare, additional third-party liability coverage, urbanicity of county/census tract, pre-period outcomes, and eligibility for other FCS programs.

• Data were balanced across a wide range individual-level characteristics, services histories, pre-period outcomes, and contextual-level measures.

3. Resulting data analyzed using a difference-in-difference approach.

• Statistical adjustments made to account for repeated observations in the comparison group and remaining differences between the treatment and matched comparison groups.


FCS Study Measures

INDEX DATEFCS Enrollment/Month Eligible for FCS Services

12 months prior

• Employment

• Chronic illness indicator

• Criminal justice involvement

• Social service use

• Medical and behavioral health service history

• Homelessness

24 months prior

• Mental health indicators

• Receipt of psychotropic medication

• Substance use disorder treatment need

Pre-Period Post-Period

Prior year (5-year moving average)

• Contextual-level factors

6 months before enrollment

• Employment and earnings (SE)

• ED visits

• Inpatient hospitalizations

• Demographics

• Household characteristics

6 months after enrollment

• Employment and earnings (SE)

• ED visits

• Inpatient hospitalizations

• Housed in Department of Commerce project (SH)

• Transitioned out of homelessness (SH)


Study Limitations and Caveats

1. Programs were still maturing during the evaluation window.

2. Treatment effects are based on an intent-to-treat analysis. Estimated effects are for enrolled individuals regardless of actual service receipt.

3. Certain outcomes such as the timing of changes in housing status are more challenging to capture using administrative data.

4. Due to data lags, these analyses use six-month pre-/post-enrollment measures to assess program effects; we do not examine long-term outcomes.

5. The number of clients enrolled in FCS programs are relatively small, making it difficult to perfectly balance treatment and control group characteristics.

6. Individuals who received FCS services may have selected into these services because of unobserved differences in health status, services needs, client motivation, etc. Matching methods may not fully mitigate selection bias.


Summary of Key Findings

Supported employment

Uniformly positive impacts on employment, earnings, and hours for both HCA and ALTSA populations

Magnitude of employment effects are relatively modest

No statistically significant impacts on ED or IP utilization

Supportive housing

Significant or promising positive impacts on transitions out of homelessness for both HCA and ALTSA populations

Promising reductions in ED utilization and IP utilization for the “HCA” population

No positive impact on ED, IP, or nursing facility utilization for ALTSA clients


Comparison Groupn = 1,484

FCS-SE Clientsn = 742



HCA Supported Employment Outcomes: Employment and EarningsComparison of outcomes 6 months prior to and 6 months following enrollment month Data is limited to individuals who entered the program as of September 30, 2018

29.6% 29.6%31.7%

43.7%

$1,059$956

$1,944

$2,162

75.570.6

126.2

156.8

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD



Any Employment. . . at least one quarter in 6-month period

Adjusted DID = +11.9%P < 0.001

Average earnings in 6-month periodAdjusted DID = $329

P = 0.06

Average hours worked in 6-month periodAdjusted DID = +36.1

P < 0.01

SOURCE: Integrated Client Repository (ICDR).


ALTSA Supported Employment Outcomes: Employment and Earnings Comparison of outcomes 6 months prior to and 6 months following enrollment month Data is limited to individuals who entered the program as of September 30, 2018

$259

$184

$267

$394

17.8

14.0

16.9

28.8

6.2% 6.2%5.5%

13.2%

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

Comparison Groupn = 742






Any Employment. . . at least one quarter in 6-month period

Adjusted DID = +8.0%P < 0.001

Average earnings in 6-month periodAdjusted DID = +$202

P = 0.02

Average hours worked in 6-month periodAdjusted DID = +15.6

P = 0.01



159.9166.9

142.1132.5

HCA Supported Employment Outcomes: Healthcare Utilization per 1,000 Member Months

Comparison of outcomes 6 months prior to and 6 months following enrollment month Data is limited to individuals who entered the program as of September 30, 2018

16.5

18.3

12.711.8

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD





Outpatient ED Visits, per 1000 Member MonthsAdjusted DID = -15.1

P = 0.26

Inpatient Hospitalizations, per 1000 Member MonthsAdjusted DID = -2.3

P = 0.53



ALTSA Supported Employment Outcomes: Healthcare Utilization per 1,000 Member Months


24.4 24.725.7

30.8

139.5

184.7

125.0

176.7

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD





Outpatient ED Visits, per 1000 Member MonthsAdjusted DID = +11.6

P = 0.66

Inpatient Hospitalizations, per 1000 Member MonthsAdjusted DID = +5.3

P = 0.42



HCA Supportive Housing Outcomes: Housing StatusComparison of outcomes 6 months prior to and 6 months following enrollment month Data is limited to individuals who entered the program as of September 30, 2018

15.5%

20.4% 19.7%

26.3%

Transitioned Out of Homelessness and Did Not Return… as of the last month of the 6-month period

Adjusted Difference = +3.7%P = 0.12

Housed in a Commerce-Funded ProjectAdjusted Difference = +7.4%

P < 0.01

POST-PERIOD

POST-PERIOD

POST-PERIOD

POST-PERIOD



FCS-SH Clientsn = 422




ALTSA Supportive Housing Outcomes: Housing StatusComparison of outcomes 6 months prior to and 6 months following enrollment month Data is limited to individuals who entered the program as of September 30, 2018



5.0%

10.9%

6.0%

8.5%

Transitioned Out of Homelessness and Did Not Return… as of the last month of the 6-month period

Adjusted Difference = +4.3%P = 0.04

Housed in a Commerce-Funded ProjectAdjusted Difference = -0.1%

P = 0.96

POST-PERIOD

POST-PERIOD

POST-PERIOD

POST-PERIOD





258.8

358.5

216.8

259.1

HCA Supportive Housing Outcomes: Healthcare Utilization per 1,000 Member Months


32.1

34.2

27.1

16.9

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD





Outpatient ED Visits, per 1000 Member MonthsAdjusted DID = -45.9

P = 0.14

Inpatient Hospitalizations, per 1000 Member MonthsAdjusted DID = -12.4

P = 0.06



392.8

478.3

276.6

409.8

ALTSA Supportive Housing Outcomes: Healthcare Utilization per 1,000 Member Months


99.8

92.9

62.7

75.3

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD





Outpatient ED Visits, per 1000 Member MonthsAdjusted DID = +71.8

P = 0.18

Inpatient Hospitalizations, per 1000 Member MonthsAdjusted DID = +22.9

P = 0.18



ALTSA Supportive Housing Outcomes: Use of LTSS ServicesComparison of outcomes 6 months prior to and 6 months following enrollment month Data is limited to individuals who entered the program as of September 30, 2018

5.5%8.0%

4.2%

9.5%

66.4%62.2%

67.4%

73.6%

PRE-PERIOD POST-

PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD

PRE-PERIOD

POST-PERIOD





Receiving In-Home ServicesAdjusted DID = +9.6%

P = 0.02

Nursing FacilityAdjusted DID = +2.8%

P = 0.28



uestions?


TECHNICAL APPENDIXBALANCE ON SELECTED BASELINE MEASURES, 6 MONTHS PRIOR TO INDEX MONTH

ALTSA-AFFILIATED CLIENTS HCA-AFFILIATED CLIENTS

Supported Employment Supportive Housing Supported Employment Supportive HousingCOMPARISON

GROUP

TREATMENT

GROUPASMD*

COMPARISON

GROUP

TREATMENT

GROUPASMD*

COMPARISON

GROUP

TREATMENT

GROUPASMD*

COMPARISON

GROUP

TREATMENT

GROUPASMD*

Employment 6.2% 6.2% 0.00 2.0% 2.0% 0.00 29.6% 29.6% 0.00 16.8% 16.8% 0.00

Average Earnings $259 $184 0.08 $128 $68 0.09 $1,059 $956 0.04 $630 $498 0.08

Average Hours Worked 17.8 14.0 0.05 8.8 5.7 0.06 75.5 70.6 0.03 48.2 37.7 0.08

Nursing Facility 3.5% 3.8% 0.01 5.5% 8.0% 0.09 — — — — — —

In-Home Services 58.4% 60.4% 0.04 66.4% 62.2% 0.09 — — — — — —

Average Member Months (MMs)

5.9 5.9 0.01 5.8 5.8 0.00 5.7 5.7 0.00 5.8 5.8 0.01

ED Outpatient Visits, per 1000 MMs

139.5 184.7 0.08 392.8 478.3 0.10 159.9 166.9 0.02 258.8 358.5 0.14

Inpatient Hospitalizations, per 1000 MMs

24.4 24.7 0.00 99.8 92.9 0.04 16.5 18.3 0.02 32.1 34.2 0.02

* Absolute standardized mean difference

Documents

The Foundational Community Supports Program: Preliminary ......Program: Preliminary Evaluation Findings Materials Prepared by Taylor Danielson, Department of Social and Health Services,